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Review
. 2022 Aug 18:4:959249.
doi: 10.3389/fmedt.2022.959249. eCollection 2022.

Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease

Chun-Ka Wong  1 , Alston Conrad Ho-On Chiu  1 , Kwong-Yue Eric Chan  1 , Shu-Yue Sze  1 , Frankie Chor-Cheung Tam  1 , Ka-Chun Un  1 , Simon Cheung-Chi Lam  1 , Hung-Fat Tse  1
Affiliations
Review

Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease

Chun-Ka Wong et al. Front Med Technol. .

Abstract

Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.

Keywords: PAD - peripheral arterial disease; TAVR - transcatheter aortic valve replacement; aortic stenosis; percutaneous transluminal angioplasty; vascular closure device.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Transcatheter aortic valve replacement (TAVR) strategies in patients with concomitant peripheral arterial disease. (B) Anatomical factors for deciding vascular access for TAVR. AS, aortic stenosis; IVL; intravascular lithotripsy; PAD, peripheral arterial disease; PTA, peripheral transluminal angioplasty; SFAR, Sheath-to-femoral ratio; TAVR, transcatheter aortic valve replacement.
Figure 2
Figure 2
Fluoroscopic images demonstrating (A) transapical approach and (B) transaortic approach. Asterisk (*) indicates transcatheter aortic valve replacement (TAVR) delivery sheath.
See this image and copyright information in PMC

References

    1. Andell P, Li X, Martinsson A, Nilsson PM, Zoller B, Smith JG, et al. . Neighborhood socioeconomic status and aortic stenosis: a Swedish study based on nationwide registries and an echocardiographic screening cohort. Int J Cardiol. (2020) 318:153–9. 10.1016/j.ijcard.2020.06.034 - DOI - PubMed
    1. Sahu AK, Sagar P, Khanna R, Kumar S, Tewari S, Kapoor A, et al. . Etiology and distribution of isolated aortic stenosis in Indian patients - a study from a large tertiary care hospital in north India. Indian Heart J. (2020) 72:272–7. 10.1016/j.ihj.2020.06.013 - DOI - PMC - PubMed
    1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. (2010) 363:1597–607. 10.1056/NEJMoa1008232 - DOI - PubMed
    1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. (2011) 364:2187–98. 10.1056/NEJMoa1103510 - DOI - PubMed
    1. Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D, et al. . Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. (2014) 63:1972–81. 10.1016/j.jacc.2014.02.556 - DOI - PubMed